Opiate dependence and injection drug use are major vectors for HIV transmission across the globe, but many nations prohibit effective opioid substitution treatment (OST). In this randomized, double-blind, placebo-controlled trial in Malaysia, subjects were assigned to placebo (n=39), oral naltrexone (n=43), or sublingual buprenorphine (n=44) after standardized 14-day residential detoxification and initiation of group drug counseling. At 24-week follow-up:

• Only two-fifths of patients remained in treatment, and only one-fourth of those who stayed in treatment avoided relapse. However,
• treatment retention was significantly higher for buprenorphine compared with naltrexone or placebo.
• time to first heroin use was significantly longer for buprenorphine compared with naltrexone  or placebo.
• time to heroin relapse (defined as 3 consecutive opiate-positive or missing urine tests) was significantly longer for buprenorphine compared with naltrexone or placebo.
• no differences were detected between oral naltrexone and placebo.

Comments by Tommie Ann Bower, MA
This is another good news/bad news study. The good news is, buprenorphine increased retention in treatment and increased the average number of days to resumption of heroin use. The bad news is, less than half of subjects remained in treatment and, of those that did, only a quarter avoided relapse. Despite these numbers, it’s clear that buprenorphine plus counseling is worth trying in the battle against heroin addiction.